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Adverse consequences of uncontrolled hypertension in China

A report, published this week in JAMA Internal Medicine, found that about one-third of Chinese adults have hypertension (ie, high blood pressure levels), but <5% of them had their blood pressure properly controlled, causing substantial burden of premature deaths. The report demonstrated that uncontrolled hypertension was the leading cause of death in China responsible for 750,000 deaths from stroke and heart attacks each year.

In collaboration with investigators from the Chinese Academy of Medical Sciences, researchers from the University of Oxford conducted a study of 0.5 million Chinese adults from 10 diverse regions of China and provided important new evidence about the burden of hypertension in China, the use of treatment and excess risks of stroke and heart disease deaths due to hypertension.

The researchers found that one-third of Chinese adults in the study population had hypertension. The prevalence of hypertension increased steeply with age, varied substantially by region and was higher among those with existing vascular disease. About one-third of those with hypertension were diagnosed; of those diagnosed, about half were treated; and, of those treated, about one-third had their hypertension controlled, resulting in <5% of hypertensives with properly controlled blood pressure.

Dr Sarah Lewington, from the University of Oxford, UK, a lead author of the report, says: 'Detection and adequate treatment of hypertension in primary care has a key role to play in addressing the burden of hypertension in China, and ideally efforts should be made to lower the blood pressure of all individuals at increased risk for a cardiovascular event'.

The research suggested that with just a 25% reduction in the levels of uncontrolled hypertension, as recommended by the World Health Federation, about 130,000 premature deaths could be avoided each year in China. Professor Robert Clarke from Oxford University, one of the report’s lead authors, says, 'As well as aggressive management of hypertension, public health initiatives are also required which focus on the major determinants of blood pressure at a population level – including salt intake, harmful alcohol consumption, obesity and poor home heating in winter. Importantly, these population-based approaches would have the added benefit of reducing the large proportion of vascular deaths that occur in people with so-called normal blood pressure'.

Professor Zhengming Chen, a lead author and principal investigator of the China Kadoorie Biobank from the University of Oxford says 'China’s 2030 sustainable development goals include reducing non-communicable disease mortality by a third, and monitoring the changes over time. Unless concerted efforts are made to lower blood pressure levels in China, death rates from CVD are likely to increase further over the next few decades as the adult population grows and the prevalence of hypertension in young adults increases'.

The study was funded by The Kadoorie Charitable Foundation, the Medical Research Council (MRC), the British Heart Foundation (BHF), and Wellcome Trust.